Provider Demographics
NPI:1174953129
Name:ZAVARELLA, SALVATORE (DO)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:ZAVARELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 MONTAUK HWY STE 6
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4939
Mailing Address - Country:US
Mailing Address - Phone:833-666-6066
Mailing Address - Fax:631-337-7698
Practice Address - Street 1:1175 MONTAUK HWY STE 6
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4939
Practice Address - Country:US
Practice Address - Phone:631-666-6066
Practice Address - Fax:631-337-7698
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256093207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX335795601Medicaid
NY04141966Medicaid
NYP01497730OtherMEDICARE RR
NY04141966Medicaid
TX335795601Medicaid